2930 MAPLE ST KAISER PERMANENTE 2023-12-07

NNE ELECTRICAL PERMIT APPLICTION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits • PR OJE ` I?R'I NFORMAT�..• ,• ViI ' . . Fs N�... PROJECT ADDRESS: 2930 Maple St. Everett, WA 98201 'BUILDING AREA: sq ft PROJECT TYPE: ❑ NEW CONSTRUCTION ❑ADDITION ✓❑TENANT IMPROVMENT ❑ REMODEL BUILDING USE: ❑SFR ❑TOWNHOUSE ❑ DUPLEX El ADU ❑ MULTI-FAMILY-#OF UNITS: ❑✓ COMMERCIAL M, -= ELECTRICAL A . `' •TION I A11014.&,DESCRIPTION ARK.. CONTRACT PRICE OF WORK: $ 4450 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIBE SCOPE OF WORK: Install (2) fourplex and (2) light switches in two new offices. Replace existing fluorescent 2X4 fixtures with LED 2X2 fixtures. Job Number: 1003768. THIS INSTALLATION INCLUDES THE FOLLOWING SCOPE: (SELECT ALL THAT APPLY) LINE VOLTAGE WORK? El NO 0 YES-Select Scope: El Service ❑ Feeder El Circuits-#: El Complete Re-wire LOW VOLTAGE WORK? ❑ NO El YES-#of Devices: SELECT SCOPE(REQUIRED): El Data ❑ Intercom El Thermostat ❑Audio ❑ Secure Access El Security System ❑ Fire Alarm-Installations under this permit only include electrical wiring rough-in of the system.An additional Fire Alarm Permit is required for review of device location and installation approval. ❑Other(List All): :',17ETIVIO .... .:,.. ��'.,.:, ........ �,Za ., u.» ;... .r.r.. ...�...:. ........'. IS THIS PERMIT EDUCATION, INSTITUTIONAL,HEALTH AND/OR PERSONAL CARE FACILITIES: © NO YES--See Below&Pg. 2 ✓ ofy tchhie capipgl ichaisi obno x(,s Ie ae mn etxat tiag teh)a,tA I NhD vePl read eniedw iunderstand qulil roefd WAC u2s9e6-4 Im6eBet9 0a0ll,osf etlec odlo wthien gs se ifsieccteoas oto nd op agoet2 See Page 2 require Plan Review. ARE YOU AN OWNER PERFORMING WORK AS THE CONTRACTOR WITHOUT ELECTRICAL LICENSURE: ONO EYES-See Below& Pg. 3 Pursuant to RCW 19.28.261, property owners and leaseholders cannot perform electrical work on buildings for rent, sale, or lease without the proper electrical licensing and certification, or exemption. By checking this box, I am stating that I have completed and See Page 3 signed the AFFIDAVIT on page 3 of this application to receive an exemption from this licensing/certification requirement. �. • + e �• ,� a � OWNER NAME: Kaiser Permanente TENANT BUSINESS NAME(If Commercial): Kaiser Permanente OWNER MAILING ADDRESS: STREET 2930 Maple St. CITY Everett STATE WA ZIP 98201 OWNER PHONE:425-261-1500 OWNER EMAIL: CONTRACTOR NAME: Prime Electric, Inc. CONTRACTOR ADDRESS: sTREET 3460 161st Ave SE CITY Bellevue STATE WA ZIP 98008 CONTRACTOR PHONE:425-747-5200 CONTRACTOR EMAIL:Permits@primeelectric.com CONTRACTOR LIC.#(REQUIRED):PRIMEEI134BT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 19946 PRIMARY CONTACT: EOWNER ❑✓CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:425-559-8811 Terry Cossette CONTACT EMAIL:permits@primeelectric.com AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT\ /'//�Ir#: Ryan A Brooks 8/8/19 E 4 vf'�) (6 - 0 ( I Owner/Authorized Agent Signature Date (Revised 1/11/2019) Page 1-Application